Assessment and pre-op
What happens at the initial assessment?
We first organise an appointment to see the child at one of the
Complex Movement Clinics. Any information from the child's local
physiotherapist and parents can be collected at this time to
support the assessment. At this appointment children will undergo a
joint initial assessment by the Consultant Paediatric Neurologist
and Physiotherapist.
The physiotherapy assessment may include a:
- Neurological examination
- Musculoskeletal screen
- Functional mobility, transfers and activities of daily
living
- Observation of posture/movements
- Pain behaviour
- Range of movement
The outcome of this assessment will be discussed in the Complex
Movement Disorder Multidisciplinary meeting, and if DBS is felt to
be an appropriate treatment option, a discussion will be had with
the family. The patient will then be placed on the list for a
baseline assessment.
During this clinic appointment the procedure will be described
in detail to the family including the risks and possible adverse
effects. Potential disadvantages to DBS therapy will also be
discussed.
Realistic objectives of DBS therapy will be discussed and agreed
collaboratively with the parents, including the importance of
regular attendance of outpatient appointments. If DBS is not deemed
to be the best treatment option, patients will be discharged from
the DBS service back to their referrer with a report to detail the
assessment findings.
DBS Baseline assessment
If a child fits the criteria and is a good candidate for DBS,
the child will be sent for neuro-physiology tests at King's College
Hospital NHS Foundation Trust in London. If the result of these
tests is satisfactory the neurosurgery team will coordinate an
admission to the Bristol Royal Hospital for Children for a
multi-disciplinary team baseline assessment. This is normally
completed over 4 days and requires an inpatient stay. As part of
these assessments, some video recordings will need to be taken of
the child. Written consent will be required for this to be
completed.
Assessments will be made by the multi-disciplinary team,
including:
- Physiotherapy
- Occupational Therapy
- Speech and Language Therapy
- Psychology
The assessment results are then discussed at a multidisciplinary
team meeting.
